Provider Demographics
NPI:1558395335
Name:LIFELINE HOME HEALTH CARE OF LEXINGTON, LLC
Entity Type:Organization
Organization Name:LIFELINE HOME HEALTH CARE OF LEXINGTON, LLC
Other - Org Name:LIFELINE HEALTH CARE OF FAYETTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GACHASSIN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:337-233-1307
Mailing Address - Street 1:PO BOX 51266
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1266
Mailing Address - Country:US
Mailing Address - Phone:337-233-1307
Mailing Address - Fax:337-233-5764
Practice Address - Street 1:100 JOHN SUTHERLAND DR STE 8
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-2424
Practice Address - Country:US
Practice Address - Phone:859-272-9787
Practice Address - Fax:859-272-4698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000503513OtherANTHEM BLUE CROSS BLUE SH
KY42000182Medicaid
KY34000315Medicaid
KY45004173Medicaid
KY42000182Medicaid